Exercise Induced Bronchoconstriction
Key Points
Key Points
- The major trigger for bronchoconstriction in a vulnerable subject is either water loss during periods of high ventilation or the addition of an osmotically active agent.
- Exercise itself is not needed to cause bronchoconstriction, just the creation of a hyperosmolar environment.
- The hyperosmolar environment leads to mast cell degranulation with release of mediators, predominately leukotrienes, but also including histamine, tryptase, and prostaglandins. In addition, eosinophils can also be activated, producing further mediators, including leukotrienes.
- The water content of the inspired air, the level achieved and maintained during exercise, or both are the major determinants of exercise-induced bronchoconstriction (EIB).
- EIB is frequently documented with asthma and reflects insufficient control of underlying asthma.
- Elite athletes have a higher prevalence of EIB than seen in the general population, varying with the intensity of exercise and the environment.
Diagnosis
Diagnosis
...Statement (SS)1: In asthmatic patients...
...sis of EIB should be confirmed by demonst...
...ate EIB in elite athletes by using object...
...: Perform a standardized bronchoprovocation (e...
...jects with no current clinical his...
...indirect graded challenge (eg, mannito...
...orm an indirect challenge (eg, exercise challenge...
...e the ventilation reached and sustained during ex...
...9: Perform EVH as the preferred surrogate challeng...
...10: If an indirect graded challenge (eg, mann...
...1: To differentiate between EIB and e...
...ne whether exercise-induced dyspnea...
...irometry, as well as detailed pulmonary...
...der a diagnosis of exercise-induced anaphylaxis...
Treatment
...atment...
...Refer to appropriate specialists (eg, cardiologis...
...: Refer patients for psychological eva...
...dule regular office visits with patients b...
...2-Adrenergic Receptor Agoni...
...escribe inhaled short-acting β2-adrenerg...
...ibe a single dose of SABA, LABA, or both on a...
...s in daily use of β2-adrenergic age...
...ukotriene Inhibito...
...21: Consider prescribing daily therapy with leukot...
...ell Stabilizers...
...Consider prescribing inhaled cromolyn s...
ICSs
...: Consider prescribing ICSs in comb...
SS24: Do NOT prescribe daily LABAs with ICS the...
...ticholinergic Agent...
...der prescribing inhaled ipratropium bromide f...
...acologic Therapy...
...rescribe pre-exercise warm-up for E...
...der with caution the recommendation of reduction...
Competitive and Elite Athlete...
SS28: Treat athletes with EIB alone in a similar...
...orithm for the Diagnosis, Treatment, a...